一种新型胸腰椎损伤分类系统的可靠性：胸腰椎损伤严重程度评分
Reliability of a novel classification system for thoracolumbar injuries: the Thoracolumbar Injury Severity Score.
作者信息
Vaccaro Alexander R, Baron Eli M, Sanfilippo James, Jacoby Sidney, Steuve Jacob, Grossman Eric, DiPaola Matthew, Ranier Paul, Austin Luke, Ropiak Ray, Ciminello Michael, Okafor Chuka, Eichenbaum Matthew, Rapuri Venkat, Smith Eric, Orozco Fabio, Ugolini Peter, Fletcher Mark, Minnich Jonathan, Goldberg Gregory, Wilsey Jared, Lee Joon Y, Lim Moe R, Burns Anthony, Marino Ralph, DiPaola Christian, Zeiller Laura, Zeiler Steven C, Harrop James, Anderson D Greg, Albert Todd J, Hilibrand Alan S
机构信息
Thomas Jefferson University Hospital, Philadelphia, PA, USA.
出版信息
Spine (Phila Pa 1976). 2006 May 15;31(11 Suppl):S62-9; discussion S104. doi: 10.1097/01.brs.0000218072.25964.a9.
STUDY DESIGN
Prospective study of 5 spine surgeons rating 71 clinical cases of thoracolumbar spinal injuries using the Thoracolumbar Injury Severity Score (TLISS) and then re-rating the cases in a different order 1 month later.
OBJECTIVE
To determine the reliability of the TLISS system.
SUMMARY OF BACKGROUND DATA
The TLISS is a recently introduced classification system for thoracolumbar spinal column injures designed to simplify injury classification and facilitate treatment decision making. Before being widely adopted, the reliability of the TLISS must be studied.
METHODS
A total of 71 cases of thoracolumbar spinal trauma were distributed on CD-ROM to 5 attending spine surgeons, including clinical/radiographic data, details of the TLISS, and a scoring sheet in which cases would be scored using the system. The surgeons were later assigned the task with the cases reordered. Intraobserver and interobserver reliability was calculated for TLISS components, total score, and surgeon's treatment decision using the Cohen unweighted kappa coefficients and Spearman rank-order correlation.
RESULTS
Interrater reliability assessed by generalized kappa coefficients was 0.33 +/- 0.03 for injury mechanism, 0.91 +/- 0.02 for neurologic status, 0.35 +/- 0.03 for posterior ligamentous complex status, 0.29 +/- 0.02 for TLISS total, and 0.52 +/- 0.03 for treatment recommendation. Respective results using the Spearman correlation were 0.35 +/- 0.04, 0.94 +/- 0.01, 0.48 +/- 0.04, 0.65 +/- 0.03, and 0.51 +/- 0.04. Surgeons agreed with the TLISS recommendation 96.4% of the time. Intrarater kappa coefficients were 0.57 +/- 0.04 for injury mechanism, 0.93 +/- 0.02 for neurologic status, 0.48 +/- 0.04 for posterior ligamentous complex status, 0.46 +/- 0.03 for TLISS total, and 0.62 +/- 0.04 for treatment recommendation. Respective results using the Spearman correlation were 0.70 +/- 0.04, 0.95 +/- 0.02, 0.59 +/- 0.05, 0.77 +/- 0.04, and 0.59 +/- 0.05.
CONCLUSIONS
The TLISS has good reliability and compares favorably to other contemporary thoracolumbar fracture classification systems.
研究设计
一项前瞻性研究，5位脊柱外科医生使用胸腰椎损伤严重程度评分（TLISS）对71例胸腰椎脊柱损伤临床病例进行评分，然后在1个月后以不同顺序对这些病例重新评分。
目的
确定TLISS系统的可靠性。
背景数据总结
TLISS是最近推出的一种用于胸腰椎脊柱损伤的分类系统，旨在简化损伤分类并促进治疗决策。在被广泛采用之前，必须研究TLISS的可靠性。
方法
总共71例胸腰椎脊柱创伤病例以光盘形式分发给5位脊柱外科主治医生，包括临床/影像学数据、TLISS详细信息以及一份使用该系统对病例进行评分的评分表。之后给外科医生分配任务，让病例顺序重新排列。使用科恩非加权kappa系数和斯皮尔曼等级相关系数计算TLISS各组成部分、总分以及外科医生治疗决策的观察者内和观察者间可靠性。
结果
通过广义kappa系数评估的评分者间可靠性，损伤机制为0.33±0.03，神经功能状态为0.91±0.02，后韧带复合体状态为0.35±0.03，TLISS总分0.29±0.02，治疗建议为0.52±0.03。使用斯皮尔曼相关性的相应结果分别为0.35±0.04、0.94±0.01、0.48±0.04、0.65±0.03和0.51±0.04。外科医生在96.4%的情况下同意TLISS的建议。观察者内kappa系数，损伤机制为0.57±0.04，神经功能状态为0.93±0.02，后韧带复合体状态为0.48±0.04，TLISS总分0.46±0.03，治疗建议为0.62±0.04。使用斯皮尔曼相关性的相应结果分别为0.70±0.04、0.95±0.02、0.59±0.05、0.77±0.04和0.59±0.05。
结论
TLISS具有良好的可靠性，与其他当代胸腰椎骨折分类系统相比具有优势。
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